Am J Psychiatry 1997; 154:958-962
Copyright © 1997 by American Psychiatric Association
Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication?
CF Reynolds 3rd, E Frank, PR Houck, S Mazumdar, MA Dew, C Cornes, DJ Buysse, A Begley and DJ Kupfer
Mental Health Clinical Research Center for the Study of Mood Disorders, University of Pittsburgh School of Medicine, PA, USA. reynoldscf@msx.upmc.edu
OBJECTIVE: This study was conducted to identify which elderly patients with
remitted recurrent major depression remain well with maintenance
interpersonal psychotherapy after discontinuation of active antidepressant
medication (nortriptyline). METHOD: The authors examined outcomes of
maintenance therapy over 1 year for 47 elderly patients who were randomly
assigned to monthly maintenance interpersonal psychotherapy with placebo (N
= 19) or to placebo and a supportive medication clinic without
interpersonal psychotherapy (N = 28). A Kaplan-Meier survival analysis was
performed on the basis of treatment assignment and subjective sleep quality
assessed by the Pittsburgh Sleep Quality Index, on which good subjective
sleep quality is indicated by a score of 5 or lower. RESULTS: Nine (90%) of
10 patients reporting good subjective sleep quality (by 1 month into
continuation treatment) remained well for at least 1 year when treated with
monthly maintenance interpersonal psychotherapy, versus five (31%) of 16
patients with good sleep quality assigned to a medication clinic, three
(33%) of nine patients with impaired sleep quality treated with maintenance
interpersonal psychotherapy, and two (17%) of 12 patients with impaired
sleep quality assigned to a medication clinic. CONCLUSIONS: Recovery of
good subjective sleep quality by early continuation treatment is useful in
identifying which remitted elderly depressed patients will remain well with
monthly maintenance interpersonal psychotherapy, following discontinuation
of antidepressant medication, and which patients may be more vulnerable to
recurrence of major depressive episodes in the absence of antidepressant
medication.
